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Sullivan LM, Weist EM, Barrington WE, Fairchild AL, Hwang W, Kiviniemi MT, Mohammed SD, Wyant VA, Alexander LA, Magaña L. Education for public health 2030: transformation to meet health needs in a changing world. Front Public Health 2023; 11:1269272. [PMID: 38162596 PMCID: PMC10757328 DOI: 10.3389/fpubh.2023.1269272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Education for public health is at a critical inflection point, and either transforms for success or fails to remain relevant. In 2020, the Association for Schools and Programs of Public Health launched an initiative, Framing the Future 2030: Education for Public Health (FTF 2030) to develop a resilient educational system for public health that promotes scientific inquiry, connects research, education, and practice, eliminates inequities, incorporates anti-racism principles, creates and sustains diverse and inclusive teaching and learning communities, and optimizes systems and resources to prepare graduates who are clearly recognizable for their population health perspectives, knowledge, skills, attitudes, and practices. Three expert panels: (1) Inclusive excellence through an anti-racism lens; (2) Transformative approaches to teaching and learning; and (3) Expanding the reach, visibility, and impact of the field of academic public health are engaged in ongoing deliberations to generate recommendations to implement the necessary change. The article describes the panels' work completed thus far, a "Creating an Inclusive Workspace" guide, and work planned, including questions for self-evaluation, deliberation, and reflection toward actions that support academe in developing a resilient education system for public health, whether beginning or advancing through a process of change. The FTF 2030 steering committee asserts its strong commitment to structural and substantial change that strengthens academic public health as an essential component of a complex socio-political system. Lastly, all are called to join the effort as collaboration is essential to co-develop an educational system for public health that ensures health equity for all people, everywhere.
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Affiliation(s)
- Lisa M. Sullivan
- Boston University School of Public Health, Boston, MA, United States
| | - Elizabeth M. Weist
- Association of Schools and Programs of Public Health, Washington, DC, United States
| | - Wendy E. Barrington
- Center for Anti-Racism and Community Health, Health Systems and Population Health Epidemiology, University of Washington School of Public Health, Seattle, WA, United States
| | - Amy L. Fairchild
- Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, United States
| | - Wenke Hwang
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Marc T. Kiviniemi
- Department of Health, Behavior and Society, University of Kentucky College of Public Health, Lexington, KY, United States
| | - Shan D. Mohammed
- DEI Educational and Student Initiatives, Northeastern University Bouvé College of Health Sciences, Boston, MA, United States
| | - Victoria A. Wyant
- Association of Schools and Programs of Public Health, Washington, DC, United States
| | - Linda A. Alexander
- Association of Schools and Programs of Public Health, Washington, DC, United States
| | - Laura Magaña
- Association of Schools and Programs of Public Health, Washington, DC, United States
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Parasidis E, Fairchild AL. Closing the Public Health Ethics Gap. N Engl J Med 2022; 387:961-963. [PMID: 36094843 DOI: 10.1056/nejmp2207543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Efthimios Parasidis
- From the Moritz College of Law (E.P.) and the College of Public Health (E.P., A.L.F.), Ohio State University, Columbus
| | - Amy L Fairchild
- From the Moritz College of Law (E.P.) and the College of Public Health (E.P., A.L.F.), Ohio State University, Columbus
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Parasidis E, Fairchild AL. Incorporating Ethics Consultations into Public Health Practice. Am J Bioeth 2022; 22:47-50. [PMID: 35420534 DOI: 10.1080/15265161.2022.2044549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Efthimios Parasidis
- The Ohio State University Moritz College of Law
- The Ohio State University College of Public Health
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Abstract
In June 2017, the World Health Organization issued the Guidelines on Ethical Issues in Public Health Surveillance. Using the frame of public health ethics, the guidance declared that countries have an affirmative duty to undertake surveillance and that the global community had an obligation to support those countries whose resources limited their capacity. The centrality of TB surveillance has long been recognized as a matter of public health practice and ethics. Nevertheless, contemporary global realities make clear that TB surveillance falls far short of the goal of uniform notification. It is this reality that necessitated the paradoxical turn to research studies that require informed consent and human subjects' ethical review, the very burdens that mandated notification were designed to overcome.
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Affiliation(s)
- R Bayer
- Mailman School of Public Health, Columbia University, New York, NY
| | - A L Fairchild
- School of Public Health, The Ohio State University, Columbus, OH, USA
| | - M Zignol
- World Health Organization, Geneva, Switzerland
| | - K G Castro
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Roger VL, Sidney S, Fairchild AL, Howard VJ, Labarthe DR, Shay CM, Tiner AC, Whitsel LP, Rosamond WD. Recommendations for Cardiovascular Health and Disease Surveillance for 2030 and Beyond: A Policy Statement From the American Heart Association. Circulation 2020; 141:e104-e119. [DOI: 10.1161/cir.0000000000000756] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The release of the American Heart Association’s 2030 Impact Goal and associated metrics for success underscores the importance of cardiovascular health and cardiovascular disease surveillance systems for the acquisition of information sufficient to support implementation and evaluation. The aim of this policy statement is to review and comment on existing recommendations for and current approaches to cardiovascular surveillance, identify gaps, and formulate policy implications and pragmatic recommendations for transforming surveillance of cardiovascular disease and cardiovascular health in the United States. The development of community platforms coupled with widespread use of digital technologies, electronic health records, and mobile health has created new opportunities that could greatly modernize surveillance if coordinated in a pragmatic matter. However, technology and public health and scientific mandates must be merged into action. We describe the action and components necessary to create the cardiovascular health and cardiovascular disease surveillance system of the future, steps in development, and challenges that federal, state, and local governments will need to address. Development of robust policies and commitment to collaboration among professional organizations, community partners, and policy makers are critical to ultimately reduce the burden of cardiovascular disease and improve cardiovascular health and to evaluate whether national health goals are achieved.
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Fairchild AL. Objective monitoring of mosquito bednet usage and the ethical challenge of privacy revelations about study bystanders: Ethical analysis. Clin Trials 2019; 16:469-472. [PMID: 31368808 DOI: 10.1177/1740774519865869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical trials and public health surveillance of bednet use for malaria prevention involve the ongoing collection of sensitive data from private settings. This article discusses risks to bystanders, who have not consented to participating in surveillance or research, but whose behavior may nevertheless be recorded. In the case of clinical trials, community consultation and consent processes are one well-accepted way to address potential risk to bystanders. I argue that the intrusive monitoring required by some bednet trials may render this type of consent insufficient. In these cases, either bystanders should be enrolled as participants and give consent or less intrusive monitoring methods should be used. Validated monitoring methods should also have relevance for practice beyond use in a clinical trial. Considering the global impact of malaria, applying these methods to public health surveillance would be a practical use. Existing justifications for surveillance without consent, which sometimes result in coercive public health measures, could apply to the case of bednets. Particularly in cases where there is the potential for harm to others, individuals who were not the original subjects of disease reporting are often caught in the surveillance net. Although an argument can be made that malaria meets this bar, considerations of feasibility, sustainability, and trust make intrusive surveillance unsustainable in the case of a daily, lifelong behavior such as bednet use.
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Affiliation(s)
- Amy L Fairchild
- College of Public Health, The Ohio State University, Columbus, OH, USA
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Fairchild AL, Dawson A, Bayer R, Selgelid MJ. The World Health Organization, Public Health Ethics, and Surveillance: Essential Architecture for Social Well-Being. Am J Public Health 2019; 107:1596-1598. [PMID: 28902550 DOI: 10.2105/ajph.2017.304019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Amy L Fairchild
- Amy L. Fairchild is with the Department of Health Policy and Management, Texas A&M University, College Station, and is co-director of the WHO Collaborating Center for Bioethics, Columbia University, New York, NY. Angus Dawson is director of Sydney Health Ethics, School of Public Health, and with the Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia. Ronald Bayer is co-director of the Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University, and co-director of the WHO Collaborating Center for Bioethics, Columbia University. Michael J. Selgelid is director of the Monash Bioethics Center, Monash University, Melbourne, Australia, and is current chair of the Global Network of WHO Collaborating Centres for Bioethics, Geneva, Switzerland
| | - Angus Dawson
- Amy L. Fairchild is with the Department of Health Policy and Management, Texas A&M University, College Station, and is co-director of the WHO Collaborating Center for Bioethics, Columbia University, New York, NY. Angus Dawson is director of Sydney Health Ethics, School of Public Health, and with the Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia. Ronald Bayer is co-director of the Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University, and co-director of the WHO Collaborating Center for Bioethics, Columbia University. Michael J. Selgelid is director of the Monash Bioethics Center, Monash University, Melbourne, Australia, and is current chair of the Global Network of WHO Collaborating Centres for Bioethics, Geneva, Switzerland
| | - Ronald Bayer
- Amy L. Fairchild is with the Department of Health Policy and Management, Texas A&M University, College Station, and is co-director of the WHO Collaborating Center for Bioethics, Columbia University, New York, NY. Angus Dawson is director of Sydney Health Ethics, School of Public Health, and with the Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia. Ronald Bayer is co-director of the Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University, and co-director of the WHO Collaborating Center for Bioethics, Columbia University. Michael J. Selgelid is director of the Monash Bioethics Center, Monash University, Melbourne, Australia, and is current chair of the Global Network of WHO Collaborating Centres for Bioethics, Geneva, Switzerland
| | - Michael J Selgelid
- Amy L. Fairchild is with the Department of Health Policy and Management, Texas A&M University, College Station, and is co-director of the WHO Collaborating Center for Bioethics, Columbia University, New York, NY. Angus Dawson is director of Sydney Health Ethics, School of Public Health, and with the Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia. Ronald Bayer is co-director of the Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University, and co-director of the WHO Collaborating Center for Bioethics, Columbia University. Michael J. Selgelid is director of the Monash Bioethics Center, Monash University, Melbourne, Australia, and is current chair of the Global Network of WHO Collaborating Centres for Bioethics, Geneva, Switzerland
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Fairchild AL, Holyfield LJ, Byington CL. National Academies of Sciences, Engineering, and Medicine Report on Sexual Harassment: Making the Case for Fundamental Institutional Change. JAMA 2018; 320:873-874. [PMID: 30128569 DOI: 10.1001/jama.2018.10840] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amy L Fairchild
- School of Public Health, Texas A&M University Health Sciences Center, Bryan, Texas
| | - Lavern J Holyfield
- College of Dentistry, Texas A&M University Health Sciences Center, Dallas, Texas
| | - Carrie L Byington
- College of Medicine, Texas A&M University Health Sciences Center, Bryan, Texas
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Affiliation(s)
- Amy L Fairchild
- From the School of Public Health, Texas A&M University, College Station (A.L.F., J.S.L.); the Mailman School of Public Health, Columbia University, New York (R.B.); and the Rollins School of Public Health, Emory University, Atlanta (J.C.)
| | - Ju Sung Lee
- From the School of Public Health, Texas A&M University, College Station (A.L.F., J.S.L.); the Mailman School of Public Health, Columbia University, New York (R.B.); and the Rollins School of Public Health, Emory University, Atlanta (J.C.)
| | - Ronald Bayer
- From the School of Public Health, Texas A&M University, College Station (A.L.F., J.S.L.); the Mailman School of Public Health, Columbia University, New York (R.B.); and the Rollins School of Public Health, Emory University, Atlanta (J.C.)
| | - James Curran
- From the School of Public Health, Texas A&M University, College Station (A.L.F., J.S.L.); the Mailman School of Public Health, Columbia University, New York (R.B.); and the Rollins School of Public Health, Emory University, Atlanta (J.C.)
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Fairchild AL, Haghdoost AA, Bayer R, Selgelid MJ, Dawson A, Saxena A, Reis A. Ethics of public health surveillance: new guidelines. Lancet Public Health 2017; 2:e348-e349. [PMID: 29253471 DOI: 10.1016/s2468-2667(17)30136-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 06/16/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Amy L Fairchild
- Department of Health Policy and Management, Texas A&M University School of Public Health, College Station, TX 77843, USA; WHO Collaborating Center for Bioethics, Department of Sociomedical Sciences, Columbia University, New York, NY, USA.
| | - Ali Akbar Haghdoost
- Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ronald Bayer
- WHO Collaborating Center for Bioethics, Department of Sociomedical Sciences, Columbia University, New York, NY, USA; Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Michael J Selgelid
- Monash University Bioethics Centre, Melbourne, VIC, Australia; Global Network of WHO Collaborating Centres for Bioethics, University of Sydney, Sydney, NSW, Australia
| | - Angus Dawson
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Abha Saxena
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Andreas Reis
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
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Bateman-House A, Bayer R, Colgrove J, Fairchild AL, McMahon CE. Free to Consume? Anti-Paternalism and the Politics of New York City’s Soda Cap Saga. Public Health Ethics 2017. [DOI: 10.1093/phe/phw046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Fear-based public health campaigns have been the subject of an intense moral and empirical debate. We examined how New York City, under Mayor Michael Bloomberg, used fear-based appeals to confront three challenges to public health: high rates of tobacco use, obesity, and HIV infection. New York City's use of this type of messaging may have set a precedent. Other state and local health departments will have to navigate how and whether to use fear in a context where it is possible to assert that it can serve the interests of public health. But this will not reduce the need to carefully balance efficacy, uncertainty, stigma, marginalization, emotional burdens, justice, community participation, and scientific credibility.
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Affiliation(s)
- Amy L Fairchild
- Amy L. Fairchild is a professor in the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, in New York City
| | - Ronald Bayer
- Ronald Bayer is a professor at the Mailman School of Public Health, Columbia University
| | - James Colgrove
- James Colgrove is a professor in the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University
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Abstract
Controversy has swirled over the past three decades about the ethics of fear-based public health campaigns. The HIV/AIDS epidemic provided a context in which advocacy groups were almost uniformly hostile to any use of fear, arguing that it was inherently stigmatising and always backfired. Although this argument was often accepted within public health circles, surprisingly, the bioethicists who first grappled with this issue in terms of autonomy and coercion in the 1980s were not single-minded: fear could be autonomy-enhancing. But by the turn of the 21st century, as opponents of fear-based appeals linked them to stigmatisation, ethicists typically rejected fear as inherently unethical. The evidence has increasingly suggested that fear-based campaigns 'work.' Emotionally charged public health messages have, as a consequence, become more commonplace. We conclude that an ethics of public health, which prioritises population well-being, as contrasted with the contemporary focus of bioethics on autonomy, provides a moral warrant for ensuring that populations understand health risk 'in their guts.' This, we argue, does not relieve public health authorities from considering the burdens their efforts may impose on vulnerable populations.
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Affiliation(s)
- Ronald Bayer
- Center for the History & Ethics of Public Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Amy L Fairchild
- Center for the History & Ethics of Public Health, Mailman School of Public Health, Columbia University, New York, New York, USA
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Affiliation(s)
- Sharon H Green
- From the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York
| | - Ronald Bayer
- From the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York
| | - Amy L Fairchild
- From the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York
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Johns DM, Bayer R, Fairchild AL. Evidence and the Politics of Deimplementation: The Rise and Decline of the "Counseling and Testing" Paradigm for HIV Prevention at the US Centers for Disease Control and Prevention. Milbank Q 2016; 94:126-62. [PMID: 26994712 PMCID: PMC4941977 DOI: 10.1111/1468-0009.12183] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
POLICY POINTS In situations of scientific uncertainty, public health interventions, such as counseling for HIV infection, sometimes must be implemented before obtaining evidence of efficacy. The history of HIV counseling and testing, which served as the cornerstone of HIV prevention efforts at the US Centers for Disease Control and Prevention (CDC) for a quarter of a century, illustrates the influence of institutional resistance on public health decision making and the challenge of de-implementing well-established programs. CONTEXT In 1985, amid uncertainty about the accuracy of the new test for HIV, public health officials at the Centers for Disease Control and Prevention (CDC) and AIDS activists agreed that counseling should always be provided both before and after testing to ensure that patients were tested voluntarily and understood the meaning of their results. As the "exceptionalist" perspective that framed HIV in the early years began to recede, the purpose of HIV test counseling shifted over the next 30 years from emphasizing consent, to providing information, to encouraging behavioral change. With this increasing emphasis on prevention, HIV test counseling faced mounting doubts about whether it "worked." The CDC finally discontinued its preferred test counseling approach in October 2014. METHODS Drawing on key informant interviews with current and former CDC officials, behavioral scientists, AIDS activists, and others, along with archival material, news reports, and scientific and governmental publications, we examined the origins, development, and decline of the CDC's "counseling and testing" paradigm for HIV prevention. FINDINGS Disagreements within the CDC emerged by the 1990s over whether test counseling could be justified on the basis of efficacy and cost. Resistance to the prospect of policy change by supporters of test counseling in the CDC, gay activists for whom counseling carried important ethical and symbolic meanings, and community organizations dependent on federal funding made it difficult for the CDC to de-implement the practice. CONCLUSIONS Analyses of changes in public health policy that emphasize the impact of research evidence produced in experimental or epidemiological inquiries may overlook key social and political factors involving resistance to deimplementation that powerfully shape the relationship between science and policy.
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Affiliation(s)
- David Merritt Johns
- Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University
| | - Ronald Bayer
- Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University
| | - Amy L Fairchild
- Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University
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Abstract
Surveillance is the radar of public health. Without tracking, often by name, the incidence and prevalence of both infectious and chronic disease, health officials would be unable to understand where and how to potentially intervene or what resources might be required to protect populations. Surveillance without individual informed consent has been challenged in the name of both bioethics and human rights. In this article we contend that a robust conception of public health not only justifies surveillance but, without disregarding the need to respect individuals, provides an affirmative duty to engage in surveillance. There may be social and political circumstances in which the names of those reported cannot be protected from unwarranted disclosure and misuse for ends that have little to do with protecting the public's health. But while the potential for misuse requires an ongoing, searching scrutiny of disease surveillance, remote or hypothetical threats should not serve to undermine this vital public health activity.
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Fairchild AL, Bayer R. Negative Ads: The Authors Reply. Health Aff (Millwood) 2015; 34:1798. [DOI: 10.1377/hlthaff.2015.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bayer R, Fairchild AL. Stigma: Time for a hard conversation. International Journal of Drug Policy 2015; 26:613-4. [DOI: 10.1016/j.drugpo.2015.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/15/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
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Affiliation(s)
- Amy L Fairchild
- Department of Sociomedical Sciences, Rosenfield Building, Columbia University, New York, NY 10032, USA.
| | - Ronald Bayer
- Department of Sociomedical Sciences, Rosenfield Building, Columbia University, New York, NY 10032, USA
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Affiliation(s)
- Amy L Fairchild
- From the Center for the History and Ethics of Public Health, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York
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Affiliation(s)
- Ronald Bayer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032 USA
| | - Amy L. Fairchild
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032 USA
| | - Kim Hopper
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032 USA
| | - Constance A. Nathanson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032 USA
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Affiliation(s)
- Amy L Fairchild
- Center for the History and Ethics of Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
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Abstract
In the wake of scandal over troubling research abuses, the 1970s witnessed the birth of a new system of ethical oversight. The bioethics framework, with its emphasis on autonomy, assumed a commanding role in debates regarding how to weigh the needs of society against the rights of individuals. Yet the history of resistance to oversight underscores that some domains of science hewed to a different paradigm of accountability--one that elevated the common good over individual rights. Federal officials have now proposed to dramatically limit the reach of ethical oversight. The Institute of Medicine has called for a rollback of the federal privacy rule. The changing emphasis makes it imperative to grapple with the history of the public interest paradigm.
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Affiliation(s)
- Amy L Fairchild
- Center for the History and Ethics of Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Fairchild AL, Bayer R. Unlinked anonymous testing for HIV in developing countries: a new ethical consensus. Public Health Rep 2012; 127:115-118. [PMID: 22298932 PMCID: PMC3234388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- Amy L Fairchild
- Center for the History and Ethics of Public Health, Columbia University, Mailman School of Public Health, 722 W. 168th St., New York, NY 10032, USA.
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Affiliation(s)
- Amy L Fairchild
- Center for the History and Ethics of Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
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Fairchild AL, Rosner D, Colgrove J, Bayer R, Fried LP. The EXODUS of public health. What history can tell us about the future. Am J Public Health 2010; 100:54-63. [PMID: 19965565 PMCID: PMC2791244 DOI: 10.2105/ajph.2009.163956] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2009] [Indexed: 11/04/2022]
Abstract
We trace the shifting definitions of the American public health profession's mission as a social reform and science-based endeavor. Its authority coalesced in the late nineteenth and early twentieth centuries as public health identified itself with housing, sanitation, and labor reform efforts. The field ceded that authority to medicine and other professions as it jettisoned its social mission in favor of a science-based identity. Understanding the potential for achieving progressive social change as it moves forward will require careful consideration of the industrial, structural, and intellectual forces that oppose radical reform and the identification of constituencies with which professionals can align to bring science to bear on the most pressing challenges of the day.
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Affiliation(s)
- Amy L Fairchild
- Columbia University, Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA.
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Abstract
The control of infectious diseases has traditionally fallen to public health and the clinical care of chronic diseases to private medicine. In New York City, however, the Department of Health and Mental Hygiene (DOHMH) has recently sought to expand its responsibilities in the oversight and management of chronic-disease care. In December 2005, in an effort to control epidemic rates of diabetes, the DOHMH began implementing a bold new plan for increased disease surveillance through electronic, laboratory-based reporting of A1C test results (a robust measure of blood-sugar levels). The controversy A1C reporting produced was relatively contained, but when Dr. Thomas Frieden, New York City health commissioner, called for the state to begin tracking viral loads and drug resistance among patients with HIV, both the medical community and a wider public took notice and have started to grapple with the meaning of expanded surveillance. In the context of the past century of medical surveillance in America, we analyze the current debates, focusing first on diabetes and then HIV. We identify the points of contention that arise from the city's proposed blend of public health surveillance, disease management, and quality improvement and suggest an approach to balancing the measures' perils and promises.
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Fairchild AL, Gable L, Gostin LO, Bayer R, Sweeney P, Janssen RS. Public goods, private data: HIV and the history, ethics, and uses of identifiable public health information. Public Health Rep 2007; 122 Suppl 1:7-15. [PMID: 17354522 PMCID: PMC1804110 DOI: 10.1177/00333549071220s103] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Amy L Fairchild
- Center for the History and Ethics of Public Health, Columbia University Mailman School of Public Health, New York, NY, USA
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Abstract
In this paper I examine the mass medical inspections of immigrants to the United States from the 1890s through the 1920s. I show how, framed as it was not only by nativism and eugenics but also by national industrial imperatives and priorities, scientific medicine served dual purposes. On the one hand, the medical exam was a tool for managing cultural and biological threats to the nation. There were regional variations in medical inspections that reflected the politics of race. On the other hand, the medical exam played an important role in the process of building an unskilled, highly mobile labor force. The industrial demands of the nation provided a rationale for drawing and absorbing millions of European immigrants into the labor force. It was thus a distinct product of the political economy of immigration. It was this second function that characterized the exam for the majority of immigrants entering the nation.
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Affiliation(s)
- Ronald Bayer
- Center for the History and Ethics of Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
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Affiliation(s)
- Amy L Fairchild
- Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University, New York, NY 10502, USA.
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Abstract
Insufficient attention has been given to the ethical and legal questions surrounding mandatory evacuation in disasters and emergencies. We argue that mandatory evacuation orders entail a governmental duty both to provide for people and to decide for people: Government must trigger the provision of critical resources as well as vigorous and persistent efforts to persuade reluctant citizens to leave. Public health professionals, with their experience in weighing costs and risks in the face of uncertainty and balancing individual liberties with the need to protect the common welfare, offer a unique perspective that should be brought to bear in emergencies and disasters.
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Affiliation(s)
- Amy L Fairchild
- The Center for the History and Ethics of Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, USA.
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Abstract
As bioethics emerged in the 1960s and 1970s and began to have enormous impacts on the practice of medicine and research--fuelled, by broad socio-political changes that gave rise to the struggles of women, African Americans, gay men and lesbians, and the antiauthoritarianism impulse that characterised the New Left in democratic capitalist societies--little attention was given to the question of the ethics of public health. This was all the more striking since the core values and practices of public health, often entailing the subordination of the individual for the common good, seemed opposed to the ideological impulses of bioethics. Of what relevance is autonomy-focused bioethics for public health, with its mix of justifications including those that are either implicitly or explicitly paternalistic or that seek to impose strictures on individuals and communities in the name of collective welfare? To examine the deep divide between the central commitments of bioethics and the values that animate the practice of public health, we focus on a series of controversies implicating the concepts of privacy, liberty, and paternalism. Recognising the role of moral values in decision-making was a signal contribution of bioethics in its formative period. Over the past three decades a broad array of perspectives emerged under the rubric of bioethics but individualism remains central. As we commence the process of shaping an ethics of public health, it is clear that bioethics is the wrong place to start when thinking about the balances required in defence of the public's health.
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Affiliation(s)
- Ronald Bayer
- Center for History and Ethics of Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Affiliation(s)
- Amy L Fairchild
- Center for the History & Ethics of Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, USA
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Fairchild AL. Policies of inclusion: immigrants, disease, dependency, and American immigration policy at the dawn and dusk of the 20th century. Am J Public Health 2004; 94:528-39. [PMID: 15053996 PMCID: PMC1448289 DOI: 10.2105/ajph.94.4.528] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2003] [Indexed: 11/04/2022]
Abstract
The racial politics of immigration have punctuated national discussions about immigration at different periods in US history, particularly when concerns about losing an American way of life or American population have coincided with concerns about infectious diseases. Nevertheless, the main theme running through American immigration policy is one of inclusion. The United States has historically been a nation reliant on immigrant labor and, accordingly, the most consequential public policies regarding immigration have responded to disease and its economic burdens by seeking to control the behavior of immigrants within our borders rather than excluding immigrants at our borders.
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Affiliation(s)
- Amy L Fairchild
- Center for the History and Ethics of Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Affiliation(s)
- Amy L Fairchild
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Abstract
The appearance and spread of severe acute respiratory syndrome (SARS) on a global level raised vital legal and ethical issues. National and international responses to SARS have profound implications for 3 important ethical values: privacy, liberty, and the duty to protect the public's health. This article examines, through legal and ethical lenses, various methods that countries used in reaction to the SARS outbreak: surveillance and contact tracing, isolation and quarantine, and travel restrictions. These responses, at least in some combination, succeeded in bringing the outbreak to an end. The article articulates a set of legal and ethical recommendations for responding to infectious disease threats, seeking to reconcile the tension between the public's health and individual rights to privacy, liberty, and freedom of movement. The ethical values that inform the recommendations include the precautionary principle, the least restrictive/intrusive alternative, justice, and transparency. Development of a set of legal and ethical recommendations becomes even more essential when, as was true with SARS and will undoubtedly be the case with future epidemics, scientific uncertainty is pervasive and urgent public health action is required.
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Affiliation(s)
- Lawrence O Gostin
- Center for Law and the Public's Health at Georgetown University Law Center, Washington, DC 20001, USA.
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Abstract
As therapeutic advances in the treatment of AIDS began to emerge in the late 1980s and public health began to have more to offer than just the threat, or the perceived threat, of quarantine or partner notification, fissures began to appear in the alliance against named HIV reporting that had emerged a few years earlier. In 1989, New York City’s Health Commissioner stated that the prospects of early clinical intervention warranted “a shift toward a disease-control approach to HIV infection along the lines of classic tuberculosis practices,” including the “reporting of seropositives.”Although his proposal met with fierce and effective resistance, it is now clear that his call represented part of a national trend. The CDC continued to press for cases of HIV to he reported by name to health departments, an effort that assumed the dimensions of a campaign. It was supported by a growing number of public health officials.
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Affiliation(s)
- Amy L Fairchild
- Department of Sociomedical Sciences, Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University, USA
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Abstract
Alice considered [the idea of un-birthday presents] a little. “I llke birthday presents best,” she said at last.“You don’t know what you’re talking about!” cried Humpty Dumpty. … “[There are three hundred and sixty-four days when you might get un-birthday presents… And only one for birthday presents, you know. There’s a ‘glory’ for you!”“I don’t know what you mean by ‘glory,’” Alice said.Humpty Dumpty smiled contemptuously. “Of course you don’t—till I tell you. I meant ‘there’s a nice knock-down argument for you!’”“But ‘glory’ doesn’t mean ‘a nice knock-down argument,’” Alice objected.“When I use a word,” Humpty Dumpty said in a rather scornful tone, “it means just what I choose it to mean—neither more nor less.”
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Affiliation(s)
- Amy L Fairchild
- Department of Sociomedical Sciences, Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University, USA
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Abstract
As a group of accounts that span the decades from the mid-1940s to the present, the published polio narratives enable us to align their shifting perceptions of disability with social, cultural, and technological change. This paper identifies two distinct groups of narratives. Authors of the first group, writing between the mid-1930s and mid-1950s--a period of relative prosperity, conformity, and homogeneity--were uncomfortable with radical movements, diversity, and conflict; their narratives typically told of either full or substantial recovery. Beginning in the mid-1950s--the period of both McCarthy and the Civil Rights movement--a second wave of narratives begins to tell stories of partial to serious disability; typically, they reflect on a lifetime of coping with chronic disability. Both sets of narratives, however, represent a dialogue with Franklin Delano Roosevelt. Roosevelt himself, journalists, and the National Foundation for Infantile Paralysis all helped to create and promote a core polio narrative featuring FDR's triumph over disease and disability that would become a national myth. Yet while the early narratives reinforced the core elements of the Roosevelt myth, the later ones began to challenge them.
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Abstract
Surveillance is the radar of public health. It has provided the foundation for public health planning, intervention, and prevention. Important ethical issues regarding privacy--the extent to which name-based reporting violates the trust and assumptions made about how personal medical information will be treated--are raised by public health surveillance. This policy forum looks at the contexts of differing responses from the public health communities and general public to surveillance efforts.
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Affiliation(s)
- R Bayer
- Program in the History of Public Health and Medicine, Division of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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Affiliation(s)
- A L Fairchild
- Program in the History of Public Health and Medicine, Division of Sociomedical Sciences, The Joseph L. Mailman School of Public Health, Columbia University, New York, NY 10032-2625, USA.
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Abstract
Tuberculosis (TB) began to decline in the Western world in the mid- to late 1800s. In the United States, the disease receded until the mid-1980s, when that trend was reversed. Although the TB epidemic in the United States subsided in response to public health interventions, it sparked a controversy regarding the relative value of targeted public health measures vs broad social reform. That controversy, which echoed earlier debates calling for structural reform over public health programs, was further strengthened by the historical and demographic studies of Thomas McKeown. His influential thesis maintains that clinical and primary prevention efforts had little effect on TB mortality. In this paper, the historical literature is used to examine whether public health had a significant impact on the decline of TB mortality rates in several countries. Specifically, the paper describes the arguments for and data affirming the efficacy of 2 major public health interventions over time: segregation of those infected with pulmonary TB and eradication of bovine TB. This review finds support for the hypothesis that public health measures, along with other factors, led to falling rates of TB mortality beginning in the late 19th century.
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Affiliation(s)
- A L Fairchild
- Program in the History of Public Health and Medicine, Columbia School of Public Health, New York City, NY 10032-2625, USA.
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Abstract
The US Public Health Service began the medical examination of immigrants at US ports in 1891. By 1924, national origin had become a means to justify broad-based exclusion of immigrants after Congress passed legislation restricting immigration from southern and eastern European countries. This legislation was passed based on the alleged genetic inferiority of southern and eastern Europeans. Since 1987, the United States has prohibited the entrance of immigrants infected with the human immunodeficiency virus (HIV). On the surface, a policy of excluding individuals with an inevitably fatal "communicable disease of public health significance" rests solidly in the tradition of protecting public health. But excluding immigrants with HIV is also a policy that, in practice, resembles the 1924 tradition of selective racial restriction of immigrants from "dangerous nations." Since the early 1980s, the United States has erected barriers against immigrants from particular Caribbean and African nations, whose citizens were thought to pose a threat of infecting the US blood supply with HIV.
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Affiliation(s)
- A L Fairchild
- New York State Department of Health, AIDS Institute, New York 10001
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Fairchild AL, Gemson DH. Safety information provided to customers of New York City suntanning salons. Am J Prev Med 1992; 8:381-3. [PMID: 1482579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Little is known about the safety information tanning salon operators provide to customers or the extent to which artificial tanning salons adhere to federal regulations designed to protect customers from excessive ultraviolet radiation (UVR) exposure. We surveyed the operators of 20 artificial tanning salons in New York City from 1988 to 1989 concerning salon operating procedures and information provided to potential customers. Results revealed a disparity between known health risks of UVR exposure and safety information provided to tanning salon customers. For example, 75% of salon operators informed potential customers that artificial tanning would not cause a sunburn, and 80% informed potential customers that they would not get skin cancer from artificial tanning. Artificial tanning salons are a rapidly growing industry in the United States, with over two million customers annually. Results from this survey indicate a need for greater regulation of the tanning salon industry and for education of tanning salon operators in the risks associated with the use of artificial tanning devices.
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Affiliation(s)
- A L Fairchild
- School of Public Health, Division of Sociomedical Sciences, Columbia University, New York, NY 10032
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